VITAMIN E FOR SCARS

Vitamin E is a powerful antioxidant and should be used whenever possible as part of any anti-aging skin care regimen. It works particularly well to counteract sun damage. However, studies show vitamin E is not such a great option for scars.

Independent scientific studies show that Vitamin E:

has NO effect or actually worsens the appearance of scars in 90% of users

causes an allergic reaction (contact dermatitis) in up to 33% of users

Studies

Vitamin E does NOT improve the appearance of surgical scars and may actually worsen their appearance. 33% of users develop an allergy to topical vitamin E.More

Vitamin E does NOT improve the appearance of scars after surgery for burns.More

American dermatologists discourage the use of topical vitamin E because it is associated with a high rate of contact dermatitis. It may also decrease scar strength and cause scar widening and even wound breakdown.More

Canadian pediatricians recommend that topical vitamin E should NOT be used to treat children’s scars because of the potential adverse effects.More

Vitamin E is a generic term for a group of tocol and tocotrienol derivatives. Since the discovery that vitamin E is the major lipid soluble antioxidant in skin, this substance has been tried for the treatment of almost every type of skin lesion imaginable. Anecdotal reports claim that vitamin E speeds wound healing and improves the cosmetic outcome of burns and other wounds. Many lay people use vitamin E on a regular basis to improve the outcome of scars and several physicians recommend topical vitamin E after skin surgery or resurfacing.

Objective

We attempted to determine whether topically applied vitamin E has any effect on the cosmetic appearance of scars as suggested by multiple anectodal reports.

Methods

Fifteen patients who had undergone skin cancer removal surgery were enrolled in the study. All wounds were primarily closed in 2 layers. After the surgery, the patients were given two ointments each labeled A or B. A was Aquaphor, a regular emollient, and the B was Aquaphor mixed with vitamin E. The scars were randomly divided into parts A and B. Patients were asked to put the A ointment on part A and the B ointment on part B twice daily for 4 weeks. The study was double blinded. The physicians and the patients independently evaluated the scars for cosmetic appearance on Weeks 1, 4, and 12. The criteria was simply to recognize which side of the scar looked better if there was any difference. The patients’ and the physicians’ opinions were recorded. A third blinded investigator was shown photographs of the outcomes and their opinion was also noted.

Results

The results of this study show that topically applied vitamin E does not help in improving the cosmetic appearance of scars and leads to a high incidence of contact dermatitis.

Conclusions

This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.

Editorial note: this double-blinded, randomized study shows vitamin E does NOT improve the appearance of scars after surgery. Furthermore, topical vitamin E may actually worsen the appearance of scars. 33% of users develop an allergy to topical vitamin E in the form of contact dermatitis.

One hundred fifty-nine operative procedures for postburn contractures of interdigital webs (96), the axilla (46), or the neck (17) were prospectively randomized to be treated postoperatively for four months with a topical steroid (Aristocort A), topical vitamin e, or the base cream carrier for these drugs. The nature of the medication was blinded both to the patient and to the evaluator. Patients were followed for one year. Observations were made for range of motion, scar thickness, change in graft size, and ultimate cosmetic appearance. No beneficial effect of either vitamin E or topical steroid could be demonstrated. However, adverse reactions occurred on 16.4% of patients receiving active drug, compared to 5.9% treated with only base cream. Interestingly, the grafts initially contracted and subsequently grew to be a larger size (about 20%) than the original graft by one year. It is concluded that neither topical steroid nor topical vitamin E is effective in reducing scar formation for postburn contractures.

Editorial note: this prospective, double-blind, randomized trial shows vitamin E does NOT improve the appearance of scars after surgery for burns.

Hypertrophic scars represent an abnormal, exaggerated healing response after skin injury. In addition to cosmetic concern, scars may cause pain, pruritus, contractures and other functional impairments. Therapeutic modalities include topical medications, intralesional corticosteroids, laser therapy, and cryosurgery. Topical therapies, in particular, have become increasingly popular because of their ease of use, comfort, noninvasiveness, and relatively low cost. This review will discuss the properties and effectiveness of these agents, including pressure therapy, silicone gel sheeting and ointment, polyurethane dressing, onion extract, imiquimod 5% cream, and vitamins A and E in the prevention and treatment of hypertrophic scars.

Editorial note – The authors of this article are American dermatologists from Columbia University, Mount Sinai Hospital and the New York Medical College. On page 1030 of the article they state “Because of its ability to inhibit collagen synthesis, the use of vitamin E… in scar therapy may reduce scar tensile strength and… lead to the development of widened scars and even wound dehiscence.” They go on to say… “In conclusion, the evidence that topical vitamin E alone improves the cosmetic appearance of scars is poor. It is also associated with a high incidence of contact dermatitis. The use of vitamin E should, therefore, be discouraged.”

QUESTION: A few of my patients have been told to use vitamin E cream after surgery or repair of a laceration. What is the evidence for this suggestion, and is this treatment suitable for all patients?

ANSWER: Vitamin E is the main lipid-soluble antioxidant in the skin. Several anecdotal reports have suggested that topical use of vitamin E cream can reduce scar formation. Current evidence from the literature, however, does not support that proposition. In fact, studies report some adverse effects with use of vitamin E. Further research is needed before application of vitamin E cream becomes the standard of care.

Editorial note: this article recommends that topical vitamin E should NOT be used to treat children’s scars because of the potential side-effects.